Tom Margenau

Several readers recently sent me copies of a news story that appeared in papers around the country.

The author of that piece criticized the Social Security Administration for not updating a listing of jobs that benefit applicants might be able to do instead of going on the government dole collecting disability benefits. (The law says that a person must be unable to do any kind of work to be eligible for such payments.)

I’m sure those job listings will eventually be updated, but here is a point I need to make.

I worked for the Social Security Administration for 32 years, and in almost every one of those years, Congress passed laws designed to “fix” the disability program. Also, in each and every one of those years, there were internal SSA studies and commissions that resulted in proposals also intended to make the disability process more fair, more streamlined and at the same time, less prone to fraud and abuse.

So, what’s going on with that? Why is the disability program apparently always under scrutiny and constantly subject to congressional and administrative and media meddling?

The answer to that question is what this column is all about.

Here is the bottom line: Any disability program is an absolute mess to manage. And the Social Security disability system is even more prone to administrative nightmares because it is, by far, the biggest such program in the country.

And why is a disability program such a mess? Because it is so subjective.

For example, compare it to the Social Security retirement program. The eligibility rules for retirement are relatively cut and dried. You contact the SSA, show them a birth certificate to prove you are old enough for benefits, answer a few questions and meet a few other eligibility requirements, and you qualify for benefits.

No muss, no fuss.

But it’s a completely different story for the disability program, and that’s because it is hard to get people to agree on the answer to this question: How disabled does someone have to be to get disability benefits? One person’s disabling condition is another person’s relatively minor inconvenience.

Think of this in practical, day-to-day terms to which anyone can relate.

We all know fellow workers who call in sick because they have a case of the sniffles. On the other hand, we also know of co-workers who will show up at the workplace even though they look like they are knocking on death’s door.

In other words, we all have different interpretations of what should keep a person from being able to work.

Here is another example.

I’ve got a neighbor who has a 35-year-old son with multiple sclerosis. The son uses a wheelchair and needs other forms of help. Yet, he still goes to work every day at a local Target store.

At the same time, I’ve encountered thousands of people over the years who claim to be disabled because they have a bad back or sore knees. Is my neighbor’s son “disabled”? How about the guy with the bad back?

The government tries to make the Social Security disability program as objective as possible with a handbook full of regulations to help SSA adjudicators decide who is legally disabled and who isn’t. Teams of medical professionals are also involved in the process.

Yet, it always comes down to the fact that some government bureaucrat, after reviewing the medical evidence, consulting the professionals and employing the guidelines, will have to make a subjective decision about a person’s eligibility for disability benefits.

Let’s take that guy with the bad back. I’ll call him Frank. And we’ll say that Frank actually has some painful spinal damage. How severe should it be to qualify for disability?

He had a job that required heavy lifting. He is certainly too disabled to do that kind of work anymore. But perhaps there are other, less-strenuous jobs Frank can be trained to do.

Should he qualify for Social Security disability if he can do those other jobs? (The media report I began this column with was alleging this listing of potential jobs Frank might be able to do is outdated.)

Let’s assume Frank filed for Social Security disability and was told his spinal condition was not severe enough to get benefits.

But then he mentions that he also has high blood pressure and some hearing problems. Neither one of those conditions by itself is legally disabling — but how about all three of them together? Do they make the guy disabled?

Following this scenario, let’s assume that the initial person adjudicating Frank’s claim says no and decides he is not disabled enough according to law.

Frank is upset because he is convinced he is disabled. So, he files an appeal. And after about a yearlong wait, (because there are tens of thousands of other people who are also filing appeals), he eventually meets with a judge who interprets the disability rules a bit differently than the first adjudicator did, and he approves Frank’s claim. Frank has mixed emotions.

He’s happy his claim has been finally approved. But he’s upset it took so long. So, he writes his member of Congress and demands that something be done to improve the process. The representative agrees that the program is too strict and co-sponsors a bill with language demanding that SSA “fix” the disability program.

But is the process broken? Was the first adjudicator wrong, or was the judge too lenient? Different people will have different opinions. That’s just the nature of a subjective process.

Let’s follow Frank’s case a little further. Six months after he starts getting disability benefits, a neighbor sees him out on a ladder cleaning his gutters. It took a lot of effort, but Frank managed to do it.

The neighbor has always been a little suspicious of Frank’s disability allegations and seeing this put him over the edge. So, he contacts Social Security’s fraud department and alleges Frank is cheating the system.

He says, “This guy claims to have a bad back and can’t work, and yet I saw him up on a ladder working on his house. How can this be?”

This call triggers a fraud investigation. More SSA adjudicators examine Frank’s claim.

After interviewing Frank and obtaining updated medical records, they decide he is still legally disabled.

This upsets the neighbor even more. So, he writes his representative in Congress claiming that “the incompetent government is wasting taxpayer money by sending monthly checks to a guy who is clearly not disabled.” The sympathetic representative agrees that the program is too lenient and sponsors a bill with language demanding that SSA “fix” the disability program. And on and on it goes!

By the way, the Frank example (with the name changed) is a true story. It’s a case I was involved in about 25 years ago while working for the SSA.

If you have a Social Security question, Tom Margenau has two books with all the answers. One is called “Social Security — Simple and Smart: 10 Easy-to-Understand Fact Sheets That Will Answer All Your Questions About Social Security.” The other is “Social Security: 100 Myths and 100 Facts.” You can find the books at Amazon.com or other book outlets.

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